Clinical phenotype and allergen sensitization in the first 2 years as predictors of atopic disorders at age 5 years

World Allergy Organization Journal

Bee Wah Lee¹  Lynette Pei-Chi Shek⁵  Marion Aw⁵  Yiong Huak Chan²  Genevieve Villablanca Llanora⁴  Irvin Gerez⁴  I-Chun Kuo⁵  Gabriella Nadine Li Yuan Lee⁵  Evelyn Xiu Ling Loo³  Phaik Ling Quah⁵ 

[1] Department of Paediatrics, NUHS Tower Block, Level 12, 1E Kent Ridge Road, Singapore 119228, Singapore;Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore;Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, Singapore

关键词: Allergen sensitization;    Rhinitis;    Wheeze;    Eczema;   

Others  :  1234604
DOI  :  10.1186/s40413-015-0082-z

 received in 2015-06-16, accepted in 2015-11-03,  发布年份 2015

【 摘 要 】

Introduction

From a birth cohort of at-risk Asian infants, we prospectively investigated the role of early onset allergen sensitization and clinical phenotypes as risk factors for atopic disorders at the age of 5 years.

Methods and materials

The study recruited 253 families with a history of allergic disease in a first degree relative from an antenatal clinic in Singapore. The children were followed prospectively to assess clinical outcomes and skin prick test was performed at 2 and 5 years of age.

Results

Allergen sensitization (food and/or house dust mites) alone at 2 years of age was not associated with increased risk of wheeze and eczema at 5 years. However, the clinical phenotype (eczema and wheeze) with or without the presence of concomitant allergen sensitization at 2 years increased this risk. For eczema, eczema alone at year 2 increased the risk of eczema at year 5 (adjOR = 7.1; 95 % CI: 1.8–27.8) and this was further increased by the presence of allergen sensitization (adjOR = 25.4; 95 % CI: 4.7–138.5) and the concomitant presence of both wheeze and allergen sensitization (adjOR = 64.9; 95 % CI: 4.7–900.0). For wheeze, wheeze alone at 2 years (adjOR = 4.5; 95 % CI: 1.4 -14.8), and wheeze with concomitant allergen sensitization and eczema (adjOR = 13.9; 95 % CI: 1.2–168.5) increased the risk of wheeze at 5 years. The exception was rhinitis, where allergen sensitization alone at 2 years (adjOR = 5.6; 95 % CI: 1.1–29.2) increased the risk of rhinitis at 5 years. Early onset of eczema at 2 years also increased the risk of rhinitis (adjOR = 6.8; 95 % CI: 2.0–23.1).

Conclusion

In this Asian birth cohort, the clinical phenotype (eczema and wheeze) with or without concomitant allergen sensitization in the first 2 years of life were strong predictors of atopic disorders at 5 years.

【 授权许可】

   
2015 Quah et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Wuthrich B, Schmid-Grendelmeier P. Natural course of AEDS. Allergy. 2002; 57(3):267-8.
• [2]Martinez FD et al.. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995; 332(3):133-8.
• [3]Chiang WC et al.. Allergic rhinitis and non-allergic rhinitis in children in the tropics: Prevalence and risk associations. Pediatr Pulmonol. 2012; 47(10):1026-33.
• [4]Leynaert B et al.. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol. 2004; 113(1):86-93.
• [5]Soh SE et al.. Probiotic supplementation in the first 6 months of life in at risk Asian infants--effects on eczema and atopic sensitization at the age of 1 year. Clin Exp Allergy. 2009; 39(4):571-8.
• [6]Seymour JL et al.. Clinical effects of diaper types on the skin of normal infants and infants with atopic dermatitis. J Am Acad Dermatol. 1987; 17(6):988-97.
• [7]Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993. 186(1): 23–31.
• [8]National Asthma, E. P. Prevention, Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007. 120(5 Suppl): p. S94-138.
• [9]Bachert C et al. Allergic rhinitis and its impact on asthma. In collaboration with the World Health Organization. Executive summary of the workshop report. 7–10 December 1999, Geneva, Switzerland. Allergy. 2002;57.
• [10]Yi FC et al.. Molecular cloning of Blomia tropicalis allergens--a major source of dust mite allergens in the tropics and subtropics. Inflamm Allergy Drug Targets. 2006; 5(4):261-6.
• [11]Position paper: Allergen standardization and skin tests. The European Academy of Allergology and Clinical Immunology. Allergy. 1993; 48(14 Suppl): 48–82.
• [12]Lee AJ, Shek LP. Food allergy in Singapore: opening a new chapter. Singapore Med J. 2014; 55(5):244-7.
• [13]Andiappan AK et al.. Allergic airway diseases in a tropical urban environment are driven by dominant mono-specific sensitization against house dust mites. Allergy. 2014; 69(4):501-9.
• [14]Chew FT et al.. Sensitization to local dust-mite fauna in Singapore. Allergy. 1999; 54(11):1150-9.
• [15]Illi S et al.. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol. 2004; 113(5):925-31.
• [16]Alm B et al.. Early protective and risk factors for allergic rhinitis at age 4(1/2) yr. Pediatr Allergy Immunol. 2011; 22(4):398-404.
• [17]Kulig M et al.. Development of seasonal allergic rhinitis during the first 7 years of life. J Allergy Clin Immunol. 2000; 106(5):832-9.
• [18]Saunes M et al.. Early eczema and the risk of childhood asthma: a prospective, population-based study. BMC Pediatr. 2012; 12:168. BioMed Central Full Text
• [19]von Kobyletzki LB et al.. Eczema in early childhood is strongly associated with the development of asthma and rhinitis in a prospective cohort. BMC Dermatol. 2012; 12:11. BioMed Central Full Text
• [20]Neuman A et al.. Infant wheeze, comorbidities and school age asthma. Pediatr Allergy Immunol. 2014; 25(4):380-6.
• [21]Stern DA et al.. Wheezing and bronchial hyper-responsiveness in early childhood as predictors of newly diagnosed asthma in early adulthood: a longitudinal birth-cohort study. Lancet. 2008; 372(9643):1058-64.
• [22]Pinart M et al.. Comorbidity of eczema, rhinitis, and asthma in IgE-sensitised and non-IgE-sensitised children in MeDALL: a population-based cohort study. Lancet Respir Med. 2014; 2(2):131-40.
• [23]Veskitkul J et al.. The development of allergic rhinitis in children previously diagnosed as nonallergic rhinitis. Am J Rhinol Allergy. 2013; 27(1):43-7.
• [24]Lowe AJ et al.. The temporal sequence of allergic sensitization and onset of infantile eczema. Clin Exp Allergy. 2007; 37(4):536-42.
• [25]Brough HA et al.. Atopic dermatitis increases the effect of exposure to peanut antigen in dust on peanut sensitization and likely peanut allergy. J Allergy Clin Immunol. 2015; 135(1):164-70.
• [26]Gustafsson D, Sjoberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis--a prospective follow-up to 7 years of age. Allergy. 2000; 55(3):240-5.
• [27]Ballardini N et al.. Eczema severity in preadolescent children and its relation to sex, filaggrin mutations, asthma, rhinitis, aggravating factors and topical treatment: a report from the BAMSE birth cohort. Br J Dermatol. 2013; 168(3):588-94.
• [28]Silverberg JI, Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013; 24(5):476-86.
• [29]Gustafsson D, Sjoberg O, Foucard T. Sensitization to food and airborne allergens in children with atopic dermatitis followed up to 7 years of age. Pediatr Allergy Immunol. 2003; 14(6):448-52.
• [30]Ekback M et al.. Severe eczema in infancy can predict asthma development. A prospective study to the age of 10 years. PLoS One. 2014; 9(6):e99609.
• [31]Arshad SH et al.. Sensitization to common allergens and its association with allergic disorders at age 4 years: a whole population birth cohort study. Pediatrics. 2001; 108(2): Article ID E33
• [32]Brockow I et al.. Early allergic sensitizations and their relevance to atopic diseases in children aged 6 years: results of the GINI study. J Investig Allergol Clin Immunol. 2009; 19(3):180-7.
• [33]Kusel MM et al.. Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol. 2007; 119(5):1105-10.
• [34]Sherrill D et al.. On early sensitization to allergens and development of respiratory symptoms. Clin Exp Allergy. 1999; 29(7):905-11.
• [35]Lodge CJ et al.. House dust mite sensitization in toddlers predicts current wheeze at age 12 years. J Allergy Clin Immunol. 2011; 128(4):782-8.
• [36]Carlsten C et al.. Atopic dermatitis in a high-risk cohort: natural history, associated allergic outcomes, and risk factors. Ann Allergy Asthma Immunol. 2013; 110(1):24-8.
• [37]Tariq SM et al.. The prevalence of and risk factors for atopy in early childhood: a whole population birth cohort study. J Allergy Clin Immunol. 1998; 101(5):587-93.
• [38]Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol. 2003; 112(6 Suppl):S118-27.
• [39]van der Hulst AE, Klip H, Brand PL. Risk of developing asthma in young children with atopic eczema: a systematic review. J Allergy Clin Immunol. 2007; 120(3):565-9.
• [40]Sly PD, Kusel M, Holt PG. Do early-life viral infections cause asthma? J Allergy Clin Immunol. 2010; 125(6):1202-5.